Outcome after treatment of congenital bilateral cataract

Purpose: To evaluate long-term functional outcome after treatment of dense congenital bilateral cataract. Methods: The records of 22 consecutive children operated on before the age of 12 months at St. Erik's Eye Hospital over a 5-year period (1991-96) were reviewed retrospectively. Linear Snellen visual acuity (VA) at last check, presence of stereoacuity, nystagmus, strabismus and other complications are accounted for. Subject age at last check ranged from 4 to 9 years. Results: Visual acuity could be estimated in 19 children: the median VA of the better eye was 0.4 (range: counting fingers - 0.8) and of the fellow eye 0.15 (range: amaurosis - 0.8). In nine otherwise healthy children who were operated on early (by 1 month of age), VA varied from 0.4 to 0.8 in the better eye. Four of these children achieved stereopsis. Pupillary block glaucoma developed in five eyes (in three children). Chronic glaucoma developed in eight eyes (in five children). Glaucoma occurred predominantly in children who underwent cataract extraction during the first week of life. Two of the latter had marked microphthalmos. Conclusion: Good postoperative VA was achieved in most healthy children with dense bilateral congenital cataract when surgery was performed early (before 6-8 weeks of age). Chronic glaucoma developed predominantly when cataract extraction was performed during the first week of life.